Injury remains the leading cause of morbidity and mortality for U.S. children after the first year of life and the home is the leading location of injury for younger U.S. children. Previous trials have failed to achieve comprehensive and durable installation of home safety products to reduce exposure to injury hazards in the indoor environments of young children. Children of mothers who are eligible and enrolled in home visitation programs and children of mothers with elevated depressive symptoms have been shown to be at risk of injury in the home. Inadequate maternal supervisory behavior has been shown to increase the risk of home injury. One specific aim of this proposal is to test the efficacy of the installation of multiple, passive measures (i.e. cabinet locks, stairgates, smoke detectors, etc.) to reduce exposure to injury hazards in the homes of young children of first-time mothers and subsequent medically-attended injury. The primary outcome will be a 50% reduction in medically-attended injury due to a reduction in injury hazard exposure in children who are randomized to the intervention compared with the control group over a 24-months follow-up. A second aim is to identify sub-groups of mothers and children who benefit most from the intervention by examining potential moderators of maternal depressive symptoms, the intensity of supervisory behavior, and child temperament and activity, on the intervention and subsequent injury outcomes. We will recruit 1000 children of first-time, low-income mothers who are participating in a home visitation program. These children, at 3 to 8 months of age, will be randomized to a home safety installation intervention (experimental group) or a Reach Out and Read program (control group). The leading mechanisms of residential injury resulting in an emergency visit for US children are: cutting/piercing, struck/strike, fall, poison, and burns. Exposure to hazards related to these injury mechanisms will be modified by the comprehensive installation of safety products. At baseline and annual follow-up we will use the HOME Injury Survey, a 55-item validated instrument to quantify unintentional injury hazards in the indoor environment of homes with young children, to quantify hazards and to direct the installation intervention. This proposal will test the efficacy of an intervention to reduce exposure to injury hazards in the home and subsequent preventable and medically attended injury in young children of first-time, impoverished mothers. Residential injury results in more than 1.7 million emergency visits in children younger than 5 years of age annually in the U.S. resulting in over $3 billion in medical care costs and $800 per emergency visit. Therefore, interventions that can effect sizable reductions in childhood injury in the home could result in substantial reductions in pain and suffering while saving potentially hundreds of millions of dollars in healthcare costs. PUBLIC HEALTH RELEVANCE: Narrative This proposal will test the efficacy of an intervention to reduce exposure to injury hazards in the home and subsequent preventable and medically attended injury in young children of first-time, impoverished mothers. As residential injury results in more than 1.7 million emergency visits in children less than 5 years of age each year in the U.S. resulting in more than $3 billion in medical costs including $800 per emergency visit, interventions that can effect sizable reductions could result in substantial reductions in pain and suffering while saving potentially hundreds of millions of dollars in healthcare costs. The proposal is focused on a compelling population of households of at-risk mothers and their children less than 4 years of age.